Assessing public economic gains from expanding HPV vaccination in Portugal: a governmental perspective analysis

To assess the public economic impact of expanding human papillomavirus (HPV) vaccination coverage rates in Portugal.

A cost-benefit analysis from a macroeconomic (societal) and public economic (fiscal) was conducted to compare the current vaccination strategy to no vaccination and to alternative scenarios assuming expansions of HPV vaccination to adult males up to 26 years of age and to unvaccinated women 18-26 years of age. The long-term incidence of HPV-related diseases and attributable mortality, under different scenarios were estimated for 100 years using a dynamic transmission model (DTM). Subsequently, economic gains from reductions in HPV-related morbidity and mortality, including avoided productivity losses and healthcare costs-savings, were estimated and compared to vaccination costs. Costs and benefits were discounted at 4%.

The public health benefits of the current HPV vaccination strategy under the National Immunization Plan (NIP) are expected to reduce the cumulative 100-year societal and fiscal burden of disease by 57.8% and 59.9% compared to no vaccine, respectively. Extending HPV vaccination to adult males up to 26 years of age and to unvaccinated women 18-26 years of age is estimated to further reduce societal and fiscal burden by €124 million and €109 million, respectively. Compared to no vaccination, the current NIP results in societal and fiscal benefit-cost ratios of 4.4 and 3.8, respectively. Expanding the current HPV vaccination program would result in benefit cost ratios (BCRs) of 1.9 and 1.7 from the societal and fiscal perspectives, respectively. The BCR remained stable and >1 despite changes in projected healthcare spending over the model duration.

Expanding HPV vaccination to adult populations up to 26 years of age likely offers additional economic gains that exceed expenditures when compared to the current vaccination strategy, translating public health benefits of vaccination strategies into macroeconomic and fiscal outcomes for Portugal.